Review Antianxiety & Antidepressants

Antidepressant Drugs

Take 2-4 weeks to take effect; increases serotonin, dopamine, and norepinephrine (the happy hormones)

Common side effects of Antidepressants

Weight gain, sexual dysfunction

Monoamine Oxidase Inhibitors (MAOI)

NOT the first line treatment drug, increase the amount of norepinephrine and serotonin available

hypertensive crisis

Can occur with MAOIs when mixed with OTC cold and weight remedies, and foods containing tyramines

Side effects of MAOIs to watch for

• Constipation

• Dizziness

• Orthostatic hypotension

• hypertensive crisis

serotonin syndrome

Can occur if switching to a different anti-depressant without stopping MAOIs for 2 weeks- if switching to Prozac stop for 5 weeks in between

Side Effect: Delirium

Meperidine

An opioid that should not be given with MAOIs due to high risk for serotonin syndrome

tyramine

A substance that MAOIs break down, leading to increased norepinephrine production

increased tyramine foods

Foods to avoid with MAOIs- aged cheese, fermented foods, red wine, processed meats, pickled foods

Tricyclic Drugs (TCA)

Block reuptake of norepinephrine and serotonin

Side Effects of TCAs

• Sedation

• Orthostatic Hypotension

• Diaphoresis

• Dry Mouth

• Urinary Retention

• Dysrhythmias

Selective Serotonin Reuptake Inhibitors (SSRI)

Block the reuptake of serotonin in the synapse, increasing serotonin levels

Safest and first line treatment, switching to an MOI stop for 5 weeks in between treatments

Discontinuation syndrome

Occurs if SSRIs are stopped abruptly

bupropion (Wellbutrin)

An NDRI that increases dopamine and norepinephrine; also sold as Zyban for smoking cessation, c/i if high seizure risk because it decreases seizure threshold, has the lowest rate of weight gain

mirtazapine (Remeron)

An NASSA antidepressant, increases norepinephrine and serotonin, minimal sexual dysfunction, antiemetic, improves sleep

venlafaxine (Effexor)

An SNRI that increases blood pressure; monitor closely

antidepressant drug education

it takes time to work, take consistently not prn, increased suicide risk r/t energy increasing quicker than mood --> report thoughts immediately, avoid OTC medications + St. John Warts (an OTC antidepressant)

SSRI helpful supportive treatment for

OCD, eating disorders, depression, and anxiety

SSRI common use

depression and anxiety

SSRI common side effect

upset stomach, it will get better with time

Selective Serotonin Reuptake Inhibitors (SSRI) Meds:

• fluoxetine (Prozac)

• paroxetine (Paxil)

• sertraline (Zoloft)

• citalopram (Celexa)

• escitalopram (Lexapro)

duloxetine (Cymbalta)

an SNRI that increases BP

desvenlafaxine (Pristiq)

an SNRI that increases BP; monitor closely

phenelzine (Nardil)

a MAOI used for eating disorders like Bulimia nervosa

tranycypromine (Parnate)

an MAOI used for OCD

selegiline patch

an MAOI used for panic attacks

Tricyclin Antidepressants (TCAs) Meds:

amitriptyline (Elavil)

imipramine (Tofranil)

clomipramine (Anafranil)

trazodone (Oleptro, Desyrel)

a SARI, has sedating effects, take at bedtime for insomnia

Other SSRI side effects to watch for:

• HA

• Nausea

• Lethargy

• Fatigue

• Insomnia

• Sexual Dysfunction

• Weight Gain

Benzodiazepines

Used for short term use r/t risk of dependency; could result in withdrawal symptoms

Benzodiazepines side effects

Sedation, drowsiness, caution when driving, high fall risk, avoid grapefruit and alcohol- grapefruit increases s/s

Major adverse effect of Benzodiazepines

Respiratory depression- caution with COPD and asthma patients

Benzodiazepines caution in

COPD and asthma patients; risk for oversedation in elderly patients and patients with hepatic/liver impairment

Benzodiazepines usage

alcohol withdrawal, anxiety, insomnia, pre-procedure anxiety.

Rebound anxiety

Possible after discontinuation of benzodiazepines

alprazolam (Xanax)

An oral antianxiety drug

chlordiazepoxide (Librium)

Available in oral, IM, and IV forms

clonazepam (Klonopin)

An antianxiety drug

diazepam (Valium)

Available in oral, IV, and IM forms; caution hypotension

lorazepam (Ativan)

An oral antianxiety drug that enhances GABA effect

temazepam (Restoril)

A sedative-hypnotic used for insomnia to induce and maintain sleep

Sedative-Hypnotic caution

High fall risk in elderly patients; contraindicated in patients with respiratory depression and sleep apnea

propranolol (Inderal)

Decreases HR and BP; used for panic attacks, performance and social anxiety

propranolol side effects

Bronchospasms, may mask s/s of hypoglycemia

buspirone (BuSpar)

Doesn't make the patient dizzy or drowsy; may take 2-3 weeks for effect

hydroxyzine (Atarax, Vistaril)

Causes a prolonged QT interval leading to arrhythmias; has anticholinergic effects, take at night, caution in older adults

Sedative-hypnotic (Z-drugs)

Increases GABA activity in the brain; used for insomnia.

zolpidem (Ambien)

A sedative-hypnotic used for insomnia

eszopiclone (Lunesta)

A sedative-hypnotic used for insomnia

zaleplon (Sonata)

A sedative-hypnotic used for insomnia

Melatonin Receptor Agonists

Used for insomnia; no dependency issues

ramelteon (Rozerem)

Increases the amount of melatonin in the body; give at night

Fluroxamine interaction

DO NOT GIVE WITH ramelteon; results in dangerously high levels of melatonin

Antidepressant Drugs

Take 2-4 weeks to take effect; increases serotonin, dopamine, and norepinephrine (the happy hormones)

Common side effects of Antidepressants

Weight gain, sexual dysfunction

Monoamine Oxidase Inhibitors (MAOI)

NOT the first line treatment drug

hypertensive crisis

Can occur with MAOIs

Orthostatic hypotension

Risk associated with MAOIs; move positions slowly

serotonin syndrome

Can occur if switching to a different anti-depressant without stopping MAOIs for 2 weeks- if switching to Prozac stop for 5 weeks in between

Meperidine

An opioid that should not be given with MAOIs due to high risk for serotonin syndrome

tyramine

A substance that MAOIs break down, leading to increased norepinephrine production

Tricyclic Drugs (TCA)

Block reuptake of norepinephrine and serotonin

side effect of TCAs

-cardiotoxic- can cause arrhythmias and prolonged qt interval--> c/i if have preexisting cardio problems

-orthostatic hypotension

-anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision

Sedative Serotonin Reuptake Inhibitors (SSRI)

Block the reuptake of serotonin in the synapse, increasing serotonin levels

Discontinuation syndrome

Occurs if SSRIs are stopped abruptly

fluoxetine (Prozac)

Safest and first line treatment SSRI, if switching to an MOI stop for 5 weeks in between treatments

bupropion (Wellbutrin)

An NDRI that increases dopamine and norepinephrine; also sold as Zyban for smoking cessation, c/i if high seizure risk because it decreases seizure threshold

mirtazapine (Remeron)

An NASSA antidepressant

venlafaxine (Effexor)

An SNRI that increases blood pressure; monitor closely

hold propanolol if

BP systolic <90 or HR <60

buspirone (BuSpar) usage

anti-anxiety, enhances GABA activity, partial serotonin agonist which increases serotonin levels- take daily

Sedative-hypnotic (Z-drugs) side effects

complex sleeping effects- walking, driving, etc

Sedative-hypnotic (Z-drugs) use for

insomnia

nursing implications for Sedative-hypnotic (Z-drugs)

take at night, don't drink alcohol, get at least 7-8 hrs of sleep at night for the effects

SSRI helpful supportive treatment for

OCD, eating disorders, etc.

sertraline (Zoloft)

safest and first line treatment SSRI

duloxetine (Cymbalta)

an SNRI that increases BP

desvenlafaxine (Pristiq)

an SNRI that increases BP; monitor closely